Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0012739 (disseminated intravascular coagulation)
 8,673 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report the case of a 66-year-old woman with neurofibromatosis type 1 who developed chest wall bleeding with severe scoliosis and a giant intrathoracic meningocele. She was brought to the emergency department with acute-onset of left-sided chest pain and clinical signs of hypovolemia. Bleeding control was difficult in the first operation because the tissue was friable and there were multiple subcutaneous bleeding points. During the first operation, the patient developed disseminated intravascular coagulation, which required immediate management; therefore, the surgery was aborted and a repeat surgery was performed later to stop the bleeding. The major cause of bleeding was presumed to be the mechanical stretching of the intercostal arteries and branches of the internal thoracic artery secondary to the severe deformity of the thoracic vertebra and ribs. The massive bleeding remained as a hematoma and did not lead to development of hemothorax. This was believed to be because the giant intrathoracic meningocele supported the expansion of the hematoma and prevented the perforation of the visceral pleura. After the second operation, the hematoma shrunk gradually; however, the patient required ventilatory support because the decrease in the size of the hematoma was accompanied by the expansion of the meningocele.
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PMID:Chest wall bleeding with giant intrathoracic meningocele in neurofibromatosis type 1. 2111 35

Disseminated intravascular coagulation (DIC) is rarely encountered by spine surgeons outside of deformity or severe trauma cases. The authors report an extraordinarily unique case of refractory DIC after elective resection of multiple en plaque thoracic meningiomas in a patient with neurofibromatosis type 1. A 49-year-old man underwent T1-3 laminoplasty and expansile duraplasty for resection of multiple en plaque meningiomas for thoracic myelopathy. Intraoperatively, the patient was found to be in a state of DIC that did not resolve postoperatively despite massive transfusions of blood products. He required subsequent returns to the operating room due to recurrent epidural hematomas with resulting paraplegia. Ultimately, the wound was left open, and a wound vacuum-assisted closure (VAC) was placed to prevent further returns to the operating room. DIC persisted until the administration of recombinant factor VIIa. In this report, the authors review the mechanisms, subtypes, and approaches to treatment of DIC with a focus on the bleeding subtype. If this subtype is refractory to blood product administration (> 24 hours), recombinant factor VIIa is a safe and effective option. A wound VAC can be safely utilized with exposed dura if deemed necessary by the surgeon; however, the volume and characteristics of the output should be closely monitored. The use of unconventional surgical solutions may provide options to mitigate the morbidity associated with refractory DIC in spine surgery.
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PMID:Disseminated intravascular coagulation in spine surgery: illustrative case review and the paradigms of management. 3160 27